Provider Demographics
NPI:1578392544
Name:BLOOM CHIROPRACTIC
Entity type:Organization
Organization Name:BLOOM CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-587-7400
Mailing Address - Street 1:22904 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1641
Mailing Address - Country:US
Mailing Address - Phone:248-587-7400
Mailing Address - Fax:
Practice Address - Street 1:22904 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1641
Practice Address - Country:US
Practice Address - Phone:248-587-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty